Provider Demographics
NPI:1912671736
Name:CHORNYI, SVETLANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:CHORNYI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1888 E SUMMERRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5587
Mailing Address - Country:US
Mailing Address - Phone:208-994-2924
Mailing Address - Fax:
Practice Address - Street 1:1888 E SUMMERRIDGE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5587
Practice Address - Country:US
Practice Address - Phone:208-994-2924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP9455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist